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Background
Community-based health interventions are increasingly viewed as models of care that can bridge healthcare gaps experienced by underserved communities in the United States (US). With this study, we sought to assess the impact of such interventions, as implemented through the US HealthRise program, on hypertension and diabetes among underserved communities in Hennepin, Ramsey, and Rice Counties, Minnesota.
Methods and findings
HealthRise patient data from June 2016 to October 2018 were assessed relative to comparison patients in a difference-in-difference analysis, quantifying program impact on reducing systolic blood pressure (SBP) and hemoglobin A1c, as well as meeting clinical targets (< 140 mmHg for hypertension, < 8% Al1c for diabetes), beyond routine care. For hypertension, HealthRise participation was associated with SBP reductions in Rice (6.9 mmHg [95% confidence interval: 0.9–12.9]) and higher clinical target achievement in Hennepin (27.3 percentage-points [9.8–44.9]) and Rice (17.1 percentage-points [0.9 to 33.3]). For diabetes, HealthRise was associated with A1c decreases in Ramsey (1.3 [0.4–2.2]). Qualitative data showed the value of home visits alongside clinic-based services; however, challenges remained, including community health worker retention and program sustainability.
Conclusions
HealthRise participation had positive effects on improving hypertension and diabetes outcomes at some sites. While community-based health programs can help bridge healthcare gaps, they alone cannot fully address structural inequalities experienced by many underserved communities.

研究背景
以社区为基础的健康干预措施日益被视为一种照护模式，能够弥合美国（US）服务欠缺社区所面临的医疗保健缺口。本研究旨在评估通过美国HealthRise项目实施的此类干预措施，对明尼苏达州亨内平县、拉姆西县和赖斯县服务欠缺社区人群的高血压与糖尿病的影响。

研究方法与结果
本研究采用双重差分分析方法，以2016年6月至2018年10月的HealthRise项目患者数据为研究对象，并设置对照患者队列，量化该项目在常规诊疗之外，对收缩压（systolic blood pressure, SBP）、糖化血红蛋白（hemoglobin A1c）的降低效果，以及对达到临床目标（高血压患者收缩压<140mmHg，糖尿病患者糖化血红蛋白<8%）的提升作用。针对高血压人群，参与HealthRise项目与赖斯县患者的收缩压降低相关（降低6.9mmHg，95%置信区间：0.9~12.9mmHg），同时与亨内平县（27.3个百分点，95%置信区间：9.8~44.9）和赖斯县（17.1个百分点，95%置信区间：0.9~33.3）的临床目标达标率提升相关。针对糖尿病人群，参与HealthRise项目与拉姆西县患者的糖化血红蛋白水平降低相关（降低1.3，95%置信区间：0.4~2.2）。定性研究数据显示，联合门诊服务开展家庭访视具有较高价值；但同时仍存在诸多挑战，包括社区卫生工作者留存困难以及项目可持续性不足等问题。

研究结论
参与HealthRise项目对部分试点地区的高血压与糖尿病结局改善具有积极作用。尽管以社区为基础的健康项目能够助力弥合医疗保健缺口，但仅靠此类项目无法完全解决众多服务欠缺社区所面临的结构性不平等问题。